Journey To A New Path, PLLC
Rachael Frasier, M.Ed., LPC, CSC
800 Rockmead Dr., Suite 170
Kingwood, Texas 77339
(832) 312-0379
Informed Consent and Practice Policies
Welcome! I am pleased that you have chosen me to be your mental health professional. This document answers many questions clients often ask about counseling and psychotherapy and explains procedures, financial policy and the privacy policy used in the practice of Journey To A New Path, PLLC, Rachael Frasier, M.Ed., LPC, CSC. After reading the agreements and practices, we will discuss your questions and clarify any concerns before you sign our working agreement to begin services. Please ask about any part of the agreements and practices that you do not understand.
Counseling Process and Relationship – I believe that counseling is an interactive process between therapist and client and includes active listening, honesty, trust and mutual respect and completing outside assignments when appropriate. It also includes openly discussing concerns about the counseling process. An effective counseling relationship involves developing a healthy relationship with clear boundaries. I believe that my job as a therapist is to help the client find his or her way through what may be difficult times or situations. And although ultimately only the client can direct his or her path, I am supportive, understanding and caring through the counseling process and treat each client as an individual with individual needs. Please know that I am a professional that is committed to your welfare.
It is important to understand that we have a professional relationship. If I see you in public, I will protect your confidentiality by not acknowledging or approaching you. I will wait for you to speak to me before I acknowledge you. I will not discuss your case in any public place. Contacts, other than chance meetings will be limited to scheduled appointments.
At the first session we will discuss your presenting concern, your history and will discuss the goals you want to accomplish. If I am meeting with a minor, I will ask to first meet with the parent or guardian to discuss the above mentioned items and the unique issues of confidentiality with a minor. Children are not invited to attend the intake session with the parent or guardian. Initially, counseling often results in the client experiencing uncomfortable feelings or thoughts. Sometimes things get harder before they get better. This experience may affect the client’s relationship with family members, spouse, or other significant relationships. When you bring your child for counseling, it is imperative that you stay in the building during the session. I must be able to find you in case of emergency.
The number of sessions needed will depend upon the circumstances that are taking place in each person’s life. Each person’s journey and struggles are unique, and each person moves at a different pace. Some clients may require only a few sessions in order to reach their goals while others may take several months or possibly even longer. You, the client, are in complete control. You may choose to end our professional relationship at any time. When you are ready to terminate therapy, please allow at least one session so we can have closure. If you find that my particular style of therapy does not meet your needs, please feel free to ask for referrals to other therapists.
Basic Fees - My fee is $120 for a 45-50 minute session for adults and 40-45 minutes for children. The initial intake session fee is $130 for 60-65 minutes. Payment by cash, credit card, or check is due at the time of your session. A $35 charge will be due for all returned checks. If you are late for a session, you will be given the remainder of the session and will be charged for a full session. Professional services include, but are not limited to, office appointments, therapeutic phone calls, letters, third party consultations, correspondence, and reports and will have a fee of $120 per hour or prorated accordingly.
Forensic Rates–The standard rate if Ms. Frasier is subpoenaed, court ordered, or asked to testify in court is $300 per hour (or portion of an hour). This includes waiting and preparation for testimony, consultations with other professionals preparing for court, travel time, time spent gathering and copying documents, and court time. There will be a 4 hour minimum charge if Ms. Frasier must appear in court. Any time above the 4 hours will be charged $300 per hour rate. The fees are to be paid in full 48 hours in advance of the court appearance. Any additional fees incurred after payment will be due within 48 hours after the appearance in court. Failure to keep your account current may result in legal action or collection agency intervention. Initials ______
Cancellation and Missed Appointments - Since scheduling an appointment involves reserving a time specifically for you, a 24-hour advance notice is required for cancellations (except in the case of an emergency). If you cancel less than 24 hours before your appointment, you will be considered a NO SHOW for that visit and you will be charged the FULL FEE for that session, NOT the copay. Initials______
Insurance – If you are requesting that I bill your insurance, please fill out the Insurance Authorization and Release form provided in the therapy appointment encrypted system when you registered as new client. You are responsible for all fees not covered or reimbursed by your insurance benefits, including but not limited to, deductibles, co-payments, missed appointments, late cancellations, correspondence/reports or services not approved by your plan. It is your responsibility to determine eligibility and to determine what services are allowable under your plan. If I am not a provider for your insurance plan, you may have out-of-network benefits through your insurance company. If you have such benefits, I can provide you with a receipt that you may submit to your insurance so that you can request reimbursement.
Telephone Accessibility – I make every effort to respond to my messages promptly. I will not interrupt sessions to answer phone calls. Calls are returned during normal business hours, and I typically return calls within 24 hours. Because technical difficulties do sometimes occur, please call again if you do not receive a return phone call by the end of the next business day.
Emergency Care - If you are experiencing an emergency and need to talk to someone immediately, call 911, a telephone crisis line or go to the nearest emergency room. Please be aware that when I am out of town there is no on-call back up for my practice.
Electronic Correspondence - Please be aware that email and text messaging is not a secure means for communicating information. Thus, confidentiality cannot be guaranteed through these types of communication and it is best that you limit these correspondence types to scheduling issues. If you do send an email/text with other information, I will read it but will most likely wait until your scheduled appointment to respond to that content. If you initiate communication via email or text it will indicate your permission to communicate via these methods and you will assume risk. If you pay for services via credit card a text or email receipt may be sent and that is also not considered secure. Please limit your communication to Therapy Appointment. This is a secured encrypted system.
Clients who send emails and/or texts to Ms. Frasier outside of Therapy Appointment that concern anything other than scheduling issues will be charged $10 for each text/email. Initials ______
Consultation - In order to serve you best, I may desire to consult with colleagues or an expert in a particular area relevant to your psychotherapy. I do this without identifying information so that your privacy is protected.
Privacy Rights - Professional ethics and legal standards require that our conversations and my records (even the fact that you are a client) be kept confidential. However, under the following circumstances, I am legally and ethically obligated to breach confidentiality: (a) If you present a serious imminent danger or threat to yourself or others (b) in cases of apparent abuse or neglect of a child, an elderly person, or a disabled person (c) when required by legal proceedings. If I must breach confidentiality, the minimum amount of information will be revealed—only enough to protect you or others.
My records are stored electronically on an encrypted, password protected laptop. Texts, emails, and voicemails may also be stored on my password protected smart phone. In the event that this laptop or phone is lost or stolen, I will take measures to wipe out the data. I keep all files in an encrypted program.
As a parent or guardian, you will naturally be curious about what happens in counseling sessions with your child. It is important that your child or adolescent feel safe and able to trust the counseling relationship. It is my policy to maintain confidentiality with your child or adolescent while keeping you updated on your child’s progress. I ask you to remember that as a professional, if at any time I feel your child or adolescent is in serious danger, I will break confidentiality to share information with you and the proper authorities if necessary in order to keep your child or adolescent safe. I will inform the client before breaking confidentiality if possible.
Finally, if I want to consult with someone about the specifics of your case in order to better coordinate services (i.e. a doctor). I will request that you sign a release of information. Please review the Policies and Practices to Protect the Privacy of Your Health Information for a more extensive explanation of your privacy rights. Initials _____
Court Appearances -My focus in providing counseling and psychotherapy is on treatment and healing. It is NOT my intention tobecome involved in cases that require evaluation (either written or otherwise) or my testifying in court. You should hire a different/neutral mental health professional for any evaluation or testimony you require. This position is based on two main reasons: 1) My statements will be seen as biased in your favor because we have a therapeutic relationship, and 2) The evaluation/testimony may affect the therapeutic relationship and that relationship must come first. This applies to clients of all ages. If I am required to appear in court or conference via telephone, the CLIENT/GUARDIAN will be REQUIRED to pay my fees listed above.
Complaints – If you have concerns or complaints regarding your treatment, please talk with me first. If there is no resolution there, you may contact:
Texas State Board of Examiners of Professional Counselors:
Complaints Management and Investigative Section
P.O. Box 141369
Austin, Texas 78714-1369
Orcall 1-800-942-5540 to request the appropriate form or obtain more information.
By signing these polices,
(1) I acknowledge receipt of the Policies and Practices to Protect the Privacy of Your Health Information,
(2) I understand that the persons conducting business at800 Rockmead Dr., Suite 170, Kingwood, Texas 77339 are all sole practitioners and any legal action taken against one of the persons may not include the others.
(3) I understand and agree to the stated practice polices as listed above and
(4) I give full consent for myself or my minor child, ______,
to participate in psychotherapy. I certify that I have the legal right to seek and authorize treatment for myself or my minor child.
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Client Signature (or parent/guardian if client is a minor) Date
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Print Name (Client/Guardian)Date
I have discussed these issues with the client, parent, or guardian of the client, or other representative. My observations of this person’s behavior and responses give me no reason to believe that this person is not fully competent to give me informed and willing consent.
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Counselor SignatureDate
Revised 07/29/16